poster presented at ispor vienna 2016 lbacelar-nicolau

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  • Multiple Correspondence Analysis Factorial Plan 1-2

    Registration of each health indicator by region Association between Mortality

    and No registration of health indicators by Region (1)(2)

    HELPING DECISION-MAKERS VISUALIZE INEQUITIES IN HEALTH IMPACT ASSESSMENT: LINKED ELECTRONIC RECORDS, MORTALITY AND REGIONAL DISPARITIES IN PORTUGAL

    Bacelar-Nicolau L Rodrigues T Fernandes E Lobo MF Nisa C Azzone V Teixeira-Pinto A Rocha-Gonalves F Azevedo LF Freitas A Normand SL Costa-Pereira A Pereira Miguel J

    Methods

    Show how multivariate methods outputs visualization may help decision-makers identify inequities through health impact assessment (HIA)

    Show how a policy promoting quality of linked Electronic Health Records (EHR) regarding Acute Myocardial Infarction (AMI) patients may be associated to mortality and regional inequities.

    Data Adults (>=20 years) admitted in Portuguese NHS Hospitals with AMI diagnosis during the 2nd semester 2012, followed regularly in NHS Primary Care (PC) during 2013

    Source: SPMS/ACSS

    Variables Mortality outcome at December 31 2013

    4 PC registered indicators - Blood Pressure, Cholesterol, Triglycerides, Waist Circumference, Body Mass Index (BMI)

    5 regions - Norte, Centro, LVT, Alentejo, Algarve

    Adjustment variables - sex, age, AMI hospital readmissions during the 2nd semester 2012, surgery during hospital admission, mean admission duration>6 days, hospital diagnosis>=6

    Statistical Procedures Qui-Square and Fisher Exact tests

    Logistic Regressions simple and stratified by region, estimating crude and adjusted ORs (and 95%CI)

    Multivariate Correspondence Analysis (MCA)

    Aims Findings

    Algarve and LVT have the highest no-registration percentages for every indicator. Norte, usually followed by Algarve and Centro, have the lowest percentages.

    Globally, patients followed regularly in PC, but without registered information for all health indicators, are more than twice as likely to be deceased, than patients with information registered (OR>2.0).

    Mortality is more associated with no records for: Cholesterol, Triglycerides (OR>13.0) and Blood pressure (OR>3) in Norte; BMI in Alentejo (OR near7); Cholesterol and Triglycerides (3.17 and 4.41) in Centro.

    MCA summarizes previous findings with a clear visual graphical aid.

    Main Conclusions

    Disparities between regions are found regarding Electronic Health Records of AMI patients, but also concerning association patterns of mortality and registration of these health indicators.

    Complex multivariate methodologies generate visual outputs easily interpreted by decision-makers, exposing regional inequities regarding mortality and PC recording policies and pinpointing where action priorities may lay.

    Disclosures: Nothing to disclose. Funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011). Acknowledgments: SPMS/ACSS for kindly making available the data that made this research possible

    CUTEheart Comparative Use of Technologies for Coronary Heart Disease Harvard Medical School Portugal Program

    http://www.cuteheart.med.up.pt

    LNICOLAU@MEDICINA.ULISBOA.PT

    ISPOR 19th Annual European Congress 2016 Vienna, Austria